Combating insurance fraud while safeguarding clients

Insurance companies face an interesting challenge. Firms have to respond promptly to customers after they submit a claim. At the same time, they have to make sure that the claims are not fraudulent, which adds additional scrutiny – and time – that has to be balanced with the needs of the customer.

We always presume that our customers are honest. But at the same time, we uncover fraud to the tune of more than 5.3 million euros annually.

Brian Wahl Olsen
Claims Director

For a company dedicated to superior customer service, one thing Alm. Brand never wants to do is to wrongfully accuse its policyholders of filing deceptive insurance claims. But they have to weed out the fraudulent claims, especially in an era of increasing digital self-service, to protect honest customers’ insurance coverage and rates. And by discovering and avoiding fraud, the effort has a direct impact on the profit margins of one of Denmark’s largest and best-established insurance companies.

“To protect the vast majority of our clients from the fraudulent practices of a few, we introduced SAS Fraud Framework for Insurance,” says Claims Director Brian Wahl Olsen. “We always presume that our customers are honest. But at the same time, we uncover fraud to the tune of more than 5.3 million euros annually.”

As technology has evolved, Alm. Brand has evolved with it. Now customers who prefer to submit insurance claims online can do so easily and simply, regardless of whether they’re using a computer, smartphone or tablet.

“We are providing more self-service capabilities that allow our clients to file insurance claims at the time and place that suit them best,” says Olsen. Simultaneously, the relative anonymity from self-service filing can make it more susceptible to fraudulent claims. “To make sure that we can still find fraudsters when people electronically submit claims, we depend on strong fraud-detection processes and systems.”

Good detective work enhanced by advanced analytics

Brian Egested oversees the insurer’s investigative unit. When his team is called upon to look deeper into the circumstances surrounding an insurance claim, it’s because someone raised a red flag. Sometimes it’s a claims officer with a keen eye for the unusual. Other times it’s an anonymous tip. But most often it’s the insurance company’s fraud-detection system from SAS, which alerts the claims investigators that something seems awry.

“When we get an alert, we quickly gather as much information as we can,” says Egested. “We speak to witnesses and make surveys of the location – for example, the date and time of a house fire or car accident – and we provide information on the claimant. It’s often something we do in direct collaboration with the police.”

Weeding out the fraudulent claims before settlement

Egested explains that when Alm. Brands uses SAS’ fraud-detection solution, the evidence builds as soon as the claim is called in or added to the self-service claims system on the company’s website. The system quickly compares the history of the claimant and various aspects of the circumstances of the incident to gauge whether the case should be forwarded to the investigation unit.

“If a young man crashes a luxury car at 4 a.m. on a deserted city street, which then bursts into flames with no witnesses – and he had a similar claim two years ago – it’s worth looking into,” says Egested. “But sometimes, circumstances are not as obviously suspicious.”

Another example shows how SAS Analytics can uncover fraudulent activity. A man opened three different claims with the company simultaneously. This triggered an alert, and as the investigation deepened, Alm. Brand discovered he had insurance policies from seven companies. He was ultimately denied coverage, as he had falsified information in his application form about previous claims.

Olsen is confident that Alm. Brand can continue to build on its promise of excellent customer service while turning away those who try to defraud the company. Armed with analytics, he wants to expand the company’s focus to make customer experiences better for the honest majority.

“SAS Fraud Framework for Insurance helps us better safeguard our honest customers from price increases due to other customers’ fraud,” said Olsen. “In addition to protecting insurance rates, we want to become more analytical in our approach by getting more information about what our customers really want from us. We want our customers to feel recognized, protected and valued, no matter how they choose to connect with us.”

Challenge

Solution

Benefits

Quickly analyze claims data and gauge whether a claim should be examined by the investigation unit.

Detect fraudulent insurance claims before a settlement is paid.

Prevent rate hikes for honest customers due to fraudulent payouts.

Maintain superior customer service for policyholders.

The results illustrated in this article are specific to the particular situations, business models, data input, and computing environments described herein. Each SAS customer’s experience is unique based on business and technical variables and all statements must be considered non-typical. Actual savings, results, and performance characteristics will vary depending on individual customer configurations and conditions. SAS does not guarantee or represent that every customer will achieve similar results. The only warranties for SAS products and services are those that are set forth in the express warranty statements in the written agreement for such products and services. Nothing herein should be construed as constituting an additional warranty. Customers have shared their successes with SAS as part of an agreed-upon contractual exchange or project success summarization following a successful implementation of SAS software. Brand and product names are trademarks of their respective companies.